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Preoperative coagulation testing on a gynecologic oncology service
E R Myers1, D L Clarke-Pearson, G J Olt
1Robert Wood Johnson Clinical Scholars Program, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill.
Obstetrics and Gynecology
|March 1, 1994
Summary
Preoperative coagulation tests in gynecologic oncology patients frequently show abnormalities, particularly with fibrinogen and D-dimer. However, these tests offer limited clinical value for predicting bleeding complications.
Area of Science:
- Gynecologic Oncology
- Hematology
- Surgical Oncology
Background:
- Coagulation abnormalities are common in patients with gynecologic malignancies.
- Preoperative assessment of hemostasis is crucial for surgical safety.
Purpose of the Study:
- To evaluate the prevalence and clinical significance of abnormal preoperative coagulation tests in patients undergoing surgery for gynecologic cancer.
- To determine if routine coagulation screening aids in predicting perioperative hemorrhage or transfusion needs.
Main Methods:
- A cohort of 351 patients undergoing inpatient gynecologic oncology surgery were tested preoperatively.
- Coagulation parameters including prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, and D-dimer were analyzed.
- Outcomes included perioperative hemorrhage, reoperation, hematomas, and transfusion requirements.
Main Results:
- 3.4% had abnormal PT/PTT; 48.4% had abnormal fibrinogen; 27.3% had positive D-dimer.
- 17.7% had both elevated fibrinogen and positive D-dimer.
- Elevated fibrinogen and positive D-dimer predicted transfusion (OR 1.96), but attributable risk was low (7.7%).
Conclusions:
- Coagulation abnormalities are prevalent in gynecologic oncology surgical patients.
- Routine preoperative coagulation testing provides minimal clinically actionable information for managing bleeding risk.
- Further investigation into targeted coagulation assessment may be warranted.